How is atopic dermatitis/eczema treated?

If your child suffers from eczema or atopic dermatitis, your healthcare provider will suggest a treatment plan based on the patient’s age, symptoms, and general health.

Most patients will notice improvement with proper skin care and lifestyle changes.

Treatment is more effective when a partnership develops that includes the patient, family members, and doctor. The patient or family member providing care plays a large role in the success of the treatment plan by carefully following the doctor’s instructions, and paying attention to what is or is not helpful.

child-health-atopic dermatitis-eczema treatedThe two main goals in treating atopic dermatitis are healing the skin and preventing flares. It is important for the patient and family members to note any changes in the skin’s condition in response to treatment, and to be persistent in identifying the treatment that seems to work best.

Medications: A variety of medications are used to treat atopic dermatitis.

  • Corticosteroid creams and ointments have been used for many years to treat atopic dermatitis and other autoimmune diseases affecting the skin.
  • When topical corticosteroids are not effective, the doctor may prescribe a systemic corticosteroid, which is taken by mouth or injected instead of being applied directly to the skin. Typically, these medications are used only in resistant cases and only given for short periods of time.
  • Antibiotics to treat skin infections may necessary. If viral or fungal infections are present, the doctor may also prescribe specific medications to treat those infections.
  • Certain antihistamines that cause drowsiness can reduce nighttime scratching and allow more restful sleep when taken at bedtime. This effect can be particularly helpful for patients whose nighttime scratching makes the disease worse.
  • Topical calcineurin inhibitors decrease inflammation in the skin and help prevent flares.
  • Barrier repair moisturizers reduce water loss and work to rebuild the skin.
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Phototherapy: Use of ultraviolet A or B light waves, alone or combined, can be an effective treatment for mild to moderate dermatitis. If the doctor thinks that phototherapy may be useful to treat the symptoms of atopic dermatitis, he or she will use the minimum exposure necessary and monitor the skin carefully.

Your healthcare provider may also suggest a mix of light therapy and a drug called psoralen. (According to the Journal of the American Academy of Dermatology (11/ 1987), “Psoralens and sunlight have been used by the Egyptians and [Native American] for hundreds of years for the treatment of vitiligo. The combination of oral psoralens and artificial ultraviolet A (PUVA) therapy was approved for the management of severe psoriasis by the Food and Drug Administration in 1982. Since then PUVA therapy has been found to be an effective modality in the treatment of many cutaneous conditions.”)

Treating atopic dermatitis in infants and children
  • Give lukewarm baths.
  • Apply lubricant immediately following the bath.
  • Keep child’s fingernails filed short.
  • Select soft cotton fabrics when choosing clothing.
  • Consider using sedating antihistamines to promote sleep and reduce scratching at night.
  • Keep the child cool; avoid situations where overheating occurs.
  • Learn to recognize skin infections and seek treatment promptly.
  • Attempt to distract the child with activities to keep him or her from scratching.
  • Identify and remove irritants and allergens.
Skin care for atopic dermatitis/eczema

Healing the skin and keeping it healthy are important to prevent further damage and enhance quality of life. Developing and sticking with a daily skin care routine is critical to preventing flares.

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A lukewarm bath helps to cleanse and moisturize the skin without drying it excessively. Because soaps can be drying to the skin, the doctor may recommend use of a mild bar soap or non-soap cleanser. Bath oils are not usually helpful.

After bathing, a person should air-dry the skin, or pat it dry gently (avoiding rubbing or brisk drying), and then apply a moisturizer to seal in the water that has been absorbed into the skin during bathing. A moisturizer increases the rate of healing and establishes a barrier against further drying and irritation. Lotions that have a high water or alcohol content evaporate more quickly, and alcohol may cause stinging. Therefore, they generally are not the best choice. Creams and ointments work better at healing the skin.

Another key to protecting and restoring the skin is taking steps to avoid repeated skin infections. Signs of skin infection include tiny pustules (pus-filled bumps), oozing cracks or sores, or crusty yellow blisters. If symptoms of a skin infection develop, the doctor should be consulted and treatment should begin as soon as possible.

Protection from allergen exposure

The doctor may suggest reducing exposure to a suspected allergen. For example, the presence of the house dust mite can be limited by encasing mattresses and pillows in special dust-proof covers, frequently washing bedding in hot water, and removing carpeting. However, there is no way to completely rid the environment of airborne allergens.

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Changing the diet may not always relieve symptoms of atopic dermatitis. A change may be helpful, however, when the medical history, laboratory studies, and specific symptoms strongly suggest a food allergy. It is up to the patient and his or her family and physician to decide whether the dietary restrictions are appropriate. Unless properly monitored by a physician or dietitian, diets with many restrictions can contribute to serious nutritional problems, especially in children.

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